Category: Demographics
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NHS gender clinics do not meet quality assurance standards.
An operational and delivery review1 of adult gender clinics in England found that clinics lacked patient outcome data, had limited data reporting of inconsistent quality, and had minimal clinical audit. These failings put the clinics outside standard NHS quality assurance expectations.
These clinics also showed no signs of responding to the changing demographics of their referrals. Clinics made little effort to respond to the needs of this changing cohort, which was younger and more female than had previously been the case.
Some clinics reportedly carried out little or no knowledge-sharing or quality improvement work. Senior clinical leadership also steered some clinicians away from appropriate clinical curiosity, limiting opportunities to improve patient outcomes. In addition, many clinics were not well overseen by their local trust boards, nor by NHS England.
- Levy D, Operational and delivery review of NHS adult gender dysphoria clinics in England. https://www.england.nhs.uk/publication/operational-and-delivery-review-of-nhs-adult-gender-dysphoria-clinics-in-england/ ↩︎
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A Finnish study found detransitioners commonly had psychiatric comorbidities and childhood trauma, with most concluding their gender dysphoria arose from psychological distress rather than transgender identity.
A 2025 case series1 from Helsinki University Hospital reviewed nine adults who sought medical detransition after previously receiving “gender-affirming” treatments.
Seven were natal females and all expressed “major regret”; both natal males expressed “minor regret.” The average time from diagnosis to regret was 7 years. Patients had used hormones for an average of 7 years (median 4 years), with eight undergoing chest reconstruction/augmentation surgery and four females having reproductive organs surgically removed.
All nine had psychiatric comorbidities—mood disorders were most common (8 patients: 2 with bipolar II, 6 with depression), anxiety disorders (6 patients initially, 7 by detransition), personality disorders (3 patients, with borderline personality disorder increasing from 2 to 5 patients by detransition), and dissociative disorders (1 initially, 3 total). Childhood trauma was universal, with all having insecure attachment styles. Six reported sexual abuse/rape and six experienced school bullying. Eating disorders were diagnosed in 4 patients, with 78% having eating disorder symptoms.
Patients retrospectively believed their gender dysphoria stemmed from unresolved psychological stressors and developmental challenges rather than a stable transgender identity. The clinic has since revised its protocols to improve psychiatric screening, facilitate easier re-access for detransitioners without referrals, and emphasize clinical neutrality.
- Kettula, K., Puustinen, N., Tynkkynen, L., Lempinen, L., & Tuisku, K. (2025). Gender Dysphoria and Detransitioning in Adults: An Analysis of Nine Patients from a Gender Identity Clinic from Finland. Archives of Sexual Behavior, 54(5), 1981-1990. [Link] ↩︎
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Trans-identified females report higher rates of sexual assault than their male counterparts.
A study by Abern et al.1 surveyed 996 trans-identified adults and found that 50% of females reported experiencing sexual assault, compared to 37% of males.
- Abern, L., Diego, D., Krempasky, C., Cook, J., & Maguire, K. (2023). Prevalence of sexual assault in a cohort of transgender and gender diverse individuals. Journal of general internal medicine, 38(5), 1331-1333. [Link] ↩︎
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60% of males and 70% of females attending the world’s largest gender clinic (GIDS) are same-sex attracted
In the 2015 statistics from GIDS, approximately 60% of the youth seen there who were biological males and 70% who were biological females reported attraction to the same sex or to both sexes1.
The 2015 Gender Identity Development Service (GIDS) statistics revealed a notably high rate of same-sex attraction among the youth seen at their clinic. Over half of the biological females reported same-sex attraction, about 20% were attracted to both sexes, and a quarter to the opposite sex, with the remaining identifying as asexual. Among biological males, approximately 30% reported same-sex attraction, another 30% to both sexes, 30% to the opposite sex, with the last 10% identifying as asexual or reporting no sexual attraction.
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According to a long-range study, around 6% of children in the population are gender variant
Epidemiological study1 based on data from 1983-2007 shows that 6% of children in the population are gender variant.
- Steensma, T.D., van der Ende, J., Verhulst, F.C. & Cohen‐Kettenis, P.T. (2013). Gender Variance in Childhood and Sexual Orientation in Adulthood: A Prospective Study. J Sex Med 10 (11): 2723-2733. [Link] ↩︎
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Between 2007 and 2017, the number of transgender youth clinics in the US went from 1 to at least 41 – and the number continues to increase
A 2017 paper1 notes that:
The first transgender youth clinic in the United States opened in Boston in 2007. Since then, 40 other clinics have opened that cater exclusively to children, with new clinic openings being announced frequently.
- Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives 60 (3): 345-366. [Link] ↩︎
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The profile of people seeking transition has shifted drastically, from overwhelmingly middle-aged males to predominantly adolescent females
A 2017 paper1 notes that “in adolescents, there has been a recent inversion in the sex ratio from one favouring birth-assigned males to one favouring birth-assigned females.” By contrast, over 90% of transsexual adults in the 1960s were male2.
In fact, there was hardly any scientific literature before 2012 on girls ages 11 to 21 ever having developed gender dysphoria at all. Yet of the young people described in Lisa Littman’s 2018 seminal paper on young people3, 82.8% were female.
The data for the UK’s Gender Identity Development Service4 show that 138 children were referred in 2011, and most of those children were boys. By 2021, however, a complete sex ratio reversal had occurred, and the clinic saw 2383 children that year, with almost 70% being female.
A 2017 article by Lisa Marchiano5 collated data from different clinics around the world and found international evidence for this shift in distribution.
- Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health 14 (5): 404-411. [Link] ↩︎
- Barrett, J. (2015). Written evidence submitted by British Association of Gender Identity Specialists to the Transgender Equality Inquiry. data.parliament.uk [Link] ↩︎
- Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13 (8). [Link] ↩︎
- Gender Identity Development Service (2021). Referrals to GIDS, financial years 2010-11 to 2020-21. [Link] ↩︎
- Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives 60 (3): 345-366. [Link] ↩︎
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The District of Columbia has three and a half times more people who identify as trans than any State in the US, per head of the population
A Williams Institute survey1 found that 2.77% of the population of DC identified as trans – more than three and a half times as many as Hawaii, which (at 0.78%) had the highest proportion of trans people of all fifty States.
- Flores, A.R., Herman, J. L.; Gates, G. J. & Brown, T.N.T. (2016). How many people are lesbian, gay, bisexual, and transgender? Los Angeles, CA: The Williams Institute. [Link] ↩︎
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In 2018, one study noted that the estimated number of young people who identified as transgender ranged between 0.17% and 1.3%
A 2018 paper1 presented the results of North American studies using short (one to three item) self-reports of gender identity and its variance. The studies suggested that 0.17%–1.3% of adolescents and young adults identified as transgender.
Statistics for the transgender population are almost impossible to quantify as different definitions are used to describe the term ”transgender”. We have chosen this study for its reliability and its reasonable understanding of the term “transgender” in the twenty-first century.
- Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link] ↩︎
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There has been a roughly twenty-fold rise in the number of people seeking transition, with teenagers hugely over-represented
A 2017 paper1 reports that “the prevalence of a self-reported transgender identity in children, adolescents and adults ranges from 0.5 to 1.3%, markedly higher than prevalence rates based on clinic-referred samples of adults.”
This is reflected in data from gender clinics. The UK’s Gender Identity Development Service reported2 a twenty-fold increase in referrals over the course of the last decade:
This surge was primarily driven by adolescents, with 15 being the most common age of referral:
Similarly, a Dutch gender identity clinic reported3 a twenty-fold increase, albeit over a longer time span: from 34 in 1980 to 686 in 2015:
New Zealand4, Finland5 and Canada6 have recorded similar dramatic exponential increases.
- Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health 14 (5): 404-411. [Link] ↩︎
- Gender Identity Development Service (2021). Referrals to GIDS, financial years 2010-11 to 2020-21. [Link] ↩︎
- Wiepjes, C.M., Nota, N.M., de Blok, C.J.M., Klaver, M., de Vries, A.L.C., Wensing-Kruger, S.A., de Jongh, R.T., Bouman, M.B., Steensma, T.D., Cohen-Kettenis, P., Gooren, L.J.G., Kreukels, B.P.C. & den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. Journal of Sexual Medicine 15 (4). [Link] ↩︎
- Delahunt, J.W., Denison, H.J., Sim, D.A., Bullock, J.J. & Krebs, J.D. (2018). Increasing rates of people identifying as transgender presenting to Endocrine Services in the Wellington region. N Z Med J 131: 33-42. [Link] ↩︎
- Kaltiala-Heino, R., Sumia, M., Työläjärvi, M. & Lindberg, N. (2015). Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health 9 (1). [Link] ↩︎
- Aitken, M., Steensma, T.D., Blanchard, R., VanderLaan, D.P., Wood, H., Fuentes, A., Spegg, C., Wasserman, L., Ames, M., Fitzsimmons, C.L., Leef, J.H., Lishak, V., Reim, E., Takagi, A., Vinik, J., Wreford, J., Cohen-Kettenis, P.T., de Vries, A.L., Kreukels, B.P. & Zucker, K.J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J Sex Med 12 (3): 756-63. [Link] ↩︎